Javed
Iqbal travelled to Faisalabad International Airport 15 years ago to
catch a one-way flight to Dubai. Two years later, in 2004, he was sent
back to Pakistan after medical tests revealed that he was infected with
the human immunodeficiency virus (HIV), a precursor to acquired
immunodeficiency syndrome (AIDS). Then 27, he had no idea how and where
he had contracted the disease.
Iqbal then attempted to
move to Saudi Arabia for work, but his job application was rejected
after he underwent a medical test. Embarrassed and dejected, he resumed
his life in his native village, Chak No 127, Bhattiwala in central
Punjab’s Chiniot district, without telling anyone about his illness. He
also did not seek any treatment. He was scared of being named – and
shamed – for suffering from a disease generally perceived to be the
result of indulging in sex practices that religion and society abhor and
prohibit.
Some time later, Iqbal married a local girl
despite his deteriorating condition. He died in February this year,
leaving behind his widow who, according to a local health worker, is
also infected with HIV.
Bhattiwala
lies midway along a 37-kilometre road that connects Chiniot with
Faisalabad. Like any other village in this part of the country, it has
mud-plastered houses and herds of buffaloes meandering lazily amid its
green fields. Most of its inhabitants are small farmers who, like Iqbal,
require supplementing their meagre farm income with additional work.
The village is a picture of official neglect. It has only one government
primary school (set up in 1956-57), its drainage and sewerage systems
are primitive and it does not have a single government-run healthcare
facility.
It is by no means equipped to tackle the
HIV/AIDS scare that, in recent years, seems to have hit a large number
of people living in the village, including men, women and children as
young as five years of age, says Mazhar Qayyum, who runs a private
school near Bhattiwala. He switches between English and Urdu as he
explains how the entire village blames Iqbal for the spread of the
disease. Whether that blame is entirely justified or not is of no
consequence to villagers like Ahmed Yar who have lost almost their
entire families reportedly to HIV/AIDS.
Wearing a
worn-out shirt and a piece of unstitched cloth wrapped around his legs,
Yar is the personification of poverty and resignation. A farmer in his
30s, he has lost nine members of his family (his father, mother, six
siblings and his sister-in-law – all in the previous 12 months). They
were being treated by a local quack doctor before their condition
deteriorated and they were taken to Faisalabad’s Allied Hospital, the
largest public sector medical institution in the area. The doctors there
found that they were suffering from neurological complications. Other
than that, Yar has no test reports or other documents to prove or
disprove whether their deaths were linked to an HIV infection. “There is
no point in finding out the reason for their deaths. It will not bring
the dead back,” he says.
What he is more concerned about
is the fact that his teenaged sister has a terrible cough that never
seems to go away, and two of his paternal cousins have been found to be
infected by HIV through tests recently conducted by the government.
Another
local family has lost all its 12 members in the last two years
reportedly to HIV/AIDS. Their house is empty and its boundary wall has
all but collapsed.
In another part of the village lives
Kaneez Bibi, a housewife in her 30s, who has three young HIV-infected
patients in her home. Her four-year-old son and her two teenaged
step-children – a 16-year-old boy and a 14-year-old girl – were found to
be infected with HIV when a government team took their blood samples
for testing a few months ago. None of the three children go to school.
The eldest works in the fields despite his failing health.
On
a recent October day, Kaneez Bibi’s very agitated little son is
suffering from a bloated stomach. His hands are soiled and his skin is
ruptured and blistered. His sister walks around the house chewing her
red dupatta. She looks much younger than her age. Both the children
appear bewildered and scared.
The children receive free government-provided antiretroviral drugs that
slow HIV/AIDS, but there has been little improvement in their condition.
This could be because their parents are not observing the recommended
precautions. The tablets they consume daily are kept in the open even
when they are required to be stored away from sunlight at a temperature
below 30 degrees Celsius. The patients also need to undergo weekly
examinations by a doctor to monitor and address any side effects that
the drugs may cause.
The medicine has supporting
literature that states these recommendations very clearly but it is
written in French and English — gibberish for the children’s illiterate
parents. The doctors at the Services Hospital in Lahore who prescribed
the medicine never said anything about any dangers or precautions, says
Kaneez Bibi.
Jaffer
Ali, an agriculturist in Bhattiwala who practices medicine in his spare
time, has been the village’s main source of diagnosis and treatment of
all major and minor ailments. An untrained and unregistered medical
practitioner, he has only a smattering of information about medicine,
but every household in the village deems him their saviour. He does not
operate a clinic but visits his patients at their homes to administer
some known painkillers, steroids and antibiotics for almost all problems
or diseases. At least three other quacks similarly operate in the
village, with as little expertise. Whether or not they know how HIV/AIDS
is spread is subject to speculation, but they are certainly ill-trained
to treat its sufferers.
The quack doctors’ favourite
mode of treatment is administering injections — using one needle to give
many injections and to many people. The villagers, too, believe
injections work more quickly than tablets and syrups. Little do they
know that each injection needs to be given with a new needle to avoid
transferring one patient’s infections to another. And that could be a
major reason why HIV/AIDS has spread so widely in Bhattiwala.
Zafar
Sadhu, a local farmer, alleges that the quacks operating in the village
have known the dangers of giving injections with used needles all
along. But they would never admit that HIV/AIDS is transferred from
infected people to uninfected ones through reused injection needles.
“They would rather blame it on illicit sex than on their own wrong
medical practices,” he says.
Such blame games became
public early this year when stories of HIV/AIDS causing multiple deaths
in Bhattiwala became too frequent for the local residents to ignore.
Some of them wrote letters to Chiniot’s district administration,
requesting the authorities to carry out an investigation. They also
complained about the activities of illegal healthcare providers and
sought the appointment of a qualified doctor for the village, says
Sadhu.
A government medical team finally visited
Bhattiwala in July this year. Headed by Dr Mushtaq Bashir Akif, then
working as Chiniot’s district health officer, it took blood samples of
350 local residents randomly selected out of a total population of
approximately 4,500 people, and tested them on the spot with portable
kits. The tests found the hepatitis C virus in almost 250 of the
samples. Even more worryingly, 45 samples were found to be HIV-infected.
The medical team took additional blood samples of those
suspected to be infected with HIV and sent them to a government
laboratory in Lahore for polymerase chain reaction (PCR) testing since
on-the-spot tests are sometimes inaccurate, say health officials in
Chiniot. PCR testing is deemed 100 per cent reliable because it is
performed in a controlled laboratory environment with sophisticated
equipment. The district administration claims it has not yet received
the results of the tests from Lahore.
The electronic
media soon got wind of these developments. Many television channels
subsequently produced news pieces about those suffering from HIV/AIDS in
the village. As news spread, Dr Adnan Zafar Khan, then the director of
the Punjab AIDS Control Programme, travelled from his office in Lahore
to Chiniot to find out more about the situation first-hand. In August,
he appeared on News Wise, a news show on Dawn News TV and acknowledged
that PCR results had verified the prevalence of HIV infection in
Bhattiwala. However, he denied that there had been any deaths in the
village due to the infection.
Soon afterwards, he was
transferred out of his post as part of what the government called a
routine bureaucratic reshuffle. Sources in the Punjab health department
allege that he was punished for revealing the test results.
Dr
Mushtaq Bashir Akif denies the prevalence of HIV/AIDS in Bhattiwala
altogether. “Calling the sick people in the village as HIV positive is
incorrect,” he says during an interview in his office at Chiniot’s
District Headquarters Hospital (DHQ). Posted as medical superintendent
of the hospital this October, and dressed cheerfully on a recent
Saturday in a polo shirt with white and blue horizontal stripes, he
suggests that the ailment afflicting the village could be something
else. “Nine out of every 10 people living in Bhattiwala are suffering
from hepatitis C, just like they are in almost every village in the
area,” he says, almost chuckling.
His supervisor and
chief executive officer of the district health department, Dr Akhtar
Husain, rubbishes reports of large-scale deaths in Bhattiwala and claims
to have taken multiple precautionary measures. He closed down many
barber shops in the area since they could be a major distribution point
for HIV/AIDS infection through blades reused for shaving multiple
people. He also sealed clinics run by quack doctors in the village in
order to save people from used injection needles.
District
authorities have additionally registered a first information report
(FIR) against three quack doctors for practising medicine illegally in
Bhattiwala. Jaffer Ali’s name is not among them. He has been at large
since the government crackdown against quacks.
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